Dr Alinda Gillott & Dr Michael Craven: Mental health and Dementia
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Transcript of Dr Alinda Gillott & Dr Michael Craven: Mental health and Dementia
ITAG Community Forum Technologies in
Mental Health and Dementia
Michael Craven, NIHR MindTech HTC & University of Nottingham
Alinda Gillott, Nottinghamshire Healthcare NHS FT
www.mindtech.org.uk @NIHR_MindTech
• Introduction to MindTech – Mike
• Using technology in an NHS ADHD clinic – Alinda
• Dementia – Mike again
2
Contents
• Aim to be a catalyst for development of new technologies
• Technology evaluation
• Focusing on areas of high unmet clinical need
• Working with NHS, service users, academia & industry
• MindTech is based in the Institute of Mental Health, UoN Jubilee Campus
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NIHR Healthcare Technology Co-operatives
Nottingham MindTech: Mental Health & Dementia
Sheffield: Devices for Dignity
Cambridge: Brain Injury
Bart’s: Gastrointestinal Disease
Guy’s: Cardiovascular Disease
Leeds: Colorectal Therapies
Bradford: Wound Care
Birmingham: Trauma Management
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MindTech Partnerships
• Online peer support – evaluation of video/live therapy
• Mobile apps for mental health – safety, effectiveness & how should the NHS use them?
• Other digital technologies, including Virtual Reality
• Some medical devices e.g. cranial stimulation
• Emotion/affect detection and medication response prediction using facial cues
• Public health awareness raising e.g. ADHD (presented at ITAG 2014)
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Areas of interest
• Small NHS clinic for adults with ADHD
• Common neurodevelopmental condition
• Symptoms of inattention & distractibility,
hyperactivity & impulsivity; executive
dysfunction
• Prevalence around 2% general adult
population
• Lifelong for the majority
• Pervasive; impacts on daily life
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Using technology in the NHS setting: Adult ADHD clinic, Nottingham
• Text appointment reminders (e.g. Flo telehealth)
• Apps on smartphones
– Reminder alarms to take medication
– Electronic diaries & ‘to do’ lists (e.g. Evernote, Remember the Milk)
– Timers
• Audio recording (e.g. for lectures)
• Voice recognition software (e.g. Dragon)
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Current uses of technology in ADHD
• Appeals to the patient group (visual, interactive; use technology everyday)
• Measuring ADHD symptoms as part of diagnostic assessment
• Symptom monitoring during treatment
• Raising public awareness to reduce stigma
• Future potential in other aspects of assessment & treatment
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Potential for utilising technology in the clinic
• Traditionally utilise paper & pencil neuropsychological tests
• Laborious to administer, score & interpret
• Computerised tests of sustained attention widely available (e.g. continuous performance test; CPT)
• Trial of QbTest in our clinic (AQUA trial - ongoing)
• QbTest has added component of movement detection in addition to CPT
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Measuring ADHD symptoms in the clinic: QbTest
• Potential value in a clinic setting:
– Objective measure of symptoms
– Instantaneous analysis (saves time in manual scoring & second clinic appointment to feedback)
– Retesting can be used to measure treatment progress
• Potential barriers:
– Cost of purchase
– Not directly linked to patient data systems
– Not designed as stand-alone test (so still need to assess as usual)
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QbTest benefits & barriers
CPT implemented on a smartphone • Objective measure of attention, impulsivity
and activity • Capture of movement data from phone
sensors during the test • Early stage of development Objective • Establish whether a mobile application
combining CPT with a physical activity measure could be appropriate for monitoring symptoms in a clinical population
• Validation • User acceptance
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SnappyApp – potential for remote assessment on a smart
phone?
• Potential value in a clinic setting:
– Objective measure of symptoms
– Remote assessment & monitoring
– Could send in the data ahead of appointment (saves clinic time)
• Potential barriers:
– Unable to control the test setting & user (is it really the patient?)
– Security of data transfer to clinic
– Cost of development & maintenance
– Clinician time to review (not a patient ‘contact’)
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SnappyApp benefits & barriers
• Raising awareness (e.g. Attention Grabber, for Adult ADHD) • Information/ psychoeducation (e.g. ‘Head Meds’) • Strategies/ self-help (e.g. ‘My Journey’ EIIP app) • Broader symptom/impairment rating & monitoring • Games – SnappyApp fruit & Awkward Owls
• Advantages: – Patients like ‘NHS endorsed’ products – Increase patient engagement – Collect data ahead of clinic appointments – Reduce paper form filling – Reduce amount of clinical time?
• Barriers – NHS IT, cost, data security worries, could add to clinician time? – Patient worry it may mean fewer face-to-face appointments
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Newer digital technology - potential
Some areas of need
• encouraging daytime activity
• maintaining hobbies, interests, exercise
• company
• continence
• personal care
• mood
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Dementia and technology
• 1st generation telecare: alarms, pull cords
• 2nd generation: memory aids, other forms of
telecare
• 3rd generation: communication, smartphones, apps
• technology that people with dementia use themselves (by them) satnav, mobile phones
• that which is used with them electronic calendars, reminiscence
• that is used for them sensors, alarms, hoists after Gibson et al (2014) Dementia, doi: 10.1177/1471301214532643
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Categories of Assistive Technologies
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Classifications (continued)
• Applications where the technology is the thing
e.g. iPads, robots
or
• Applications supported by technology, where the tech is invisible or in the background
e.g. bed sensor
Also includes services, including integration of health and other records
• Technologies specifically designed for people with cognitive impairment
e.g medication
reminder
or
• Everyday technologies which lend themselves well to people with cognitive difficulties
e.g. voice recorder
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Examples 1
Memory technologies
• reminder messages
• clocks and calendars
• medication aids
• locator devices (for ‘lost’ objects)
• aids for reminiscence and leisure
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Examples 2
Telecare technologies • ‘Smart home’ sensors
– Floods – Extreme temperature – Gas
• Location – Absence from
bed/chair – Getting up in the night – Leaving the home
• Falls • Physiological sensors
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Examples 3
Communications technology
• Video links
• Home hubs
• Phone/tablet apps
• Telepresence ‘Robots’
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Examples 4
Company and ‘pets’ • Paro seal • JustoCats
Altered or virtual worlds
• Hogeweyk – dementia village in Holland
• AVED (Applied Virtual Environment for Dementia Care)
http://hogeweyk.dementiavillage.com/en/
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Areas for development
• TV / Smart TVs - Post reminders, Skype/remote calling - Make personal DVDs, run favourite films - Simplified remote controls - Observable behaviours incl. dozing, watching black screen
• Music & arts - Calming soundtracks - Group activities in care homes -Shared reading Most require close supervision
• Sensors for early diagnosis? - Detect changes in day-to-day activities e.g. use of kitchen; going out; food choice acceptability to older person?
• Intelligent lighting to support daily living - Sequencing of lights to guide tasks such as shaving, cleaning teeth etc.
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Aspirations
• Critique of conventional Assistive Technologies and its intended purpose
• More focus on Quality-of-life - ‘living well with dementia’ – not just about safety and containment
• How can technology support Autonomy, independence and self-actualisation?
• Improve access to AT appropriate technology
• Equity of access
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Some dementia tech-related projects at Nottingham
• CASA: Connecting Assistive Solutions to Aspirations (funded by Innovate UK SBRI)
• KuPA: Knowledge-based Person-centred Activity service with SINTEF-Noen AS (funded by Norwegian Research Council)
• Mindful design: EU RISE project (funded by EU Horizon 2020)
• Project details: http://www.mindtech.org.uk
Plus
• Locally running online information resources – IDEA http://idea.nottingham.ac.uk/ – ATdementia http://www.atdementia.org.uk/
• Centre for Dementia (at Institute for Mental Health) • East Midlands Research into Ageing Network
– EMRAN http://www.nottingham.ac.uk/emran
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MindTech symposium 2015
Harnessing the Digital Revolution Thursday 3rd December 2015 Royal College of Physicians, London Speakers include: • Dr Geraldine Strathdee - NHS England • Alexia Tonnel - NICE • Eve Critchley - MIND • Professor John Geddes - The University of Oxford
www.mindtech.org.uk @NIHR_MindTech
Thank you
Any questions?
www.mindtech.org.uk @NIHR_MindTech